Healthcare Provider Details

I. General information

NPI: 1356161087
Provider Name (Legal Business Name): LAURA SNIDER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 10/16/2024
Certification Date: 10/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11542 N KRISCOTT CT
ORO VALLEY AZ
85737-3718
US

IV. Provider business mailing address

11542 N KRISCOTT CT
ORO VALLEY AZ
85737-3718
US

V. Phone/Fax

Practice location:
  • Phone: 520-661-2458
  • Fax:
Mailing address:
  • Phone: 520-661-2458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: